Matching Patients to the Right EHRsBest Practices Needed for Linking Records to Patients
The issue of matching the right patients to all the right records is becoming more important as progress is made in exchanging records from multiple sources at the regional, state and, ultimately, national level. Accurate matching helps ensure the quality of care as well as patient privacy.
HIPAA originally called for creation of a universal patient identifier, but such an identifier has never been adopted because of political concerns about the privacy issues involved. But even such an identifier "is not a panacea" for making sure records are matched to the right patient, said Deven McGraw, co-chair of the tiger team, which is advising federal regulators. She's director of the health privacy project at the Center for Democracy & Technology.
Paul Egerman, a software entrepreneur who's the other co-chair, pointed out that a member of the tiger team experienced first-hand the challenges involved in patient matching when a lab test result from another patient was included in his medical record. "So this is a concern that a lot of people have expressed," he said.
EHR Matching Recommendations
The team made a series of recommendations on patient matching that the Health IT Policy Committee approved Wednesday. Now the Department of Health and Human Services' Office of the National Coordinator for Health IT will determine whether to include the recommendations in regulations and policies. ONC is spearheading efforts to carry out the provisions of the HITECH Act, including incentive payments for using electronic health records and development of statewide health information exchanges.
Highlights of the tiger team's recommendations include:
- No particular data fields should be required for matching. But standards should be specified for any field that could be used. And EHRs should be certified as accommodating those standards from data entry through data transfer. McGraw pointed out that ONC could, for example, designate Health Level Seven standards and the United States Postal Service validation/normalization program as appropriate standards.
- All healthcare organizations and health information exchanges should evaluate the effectiveness of their matching strategies and improve accuracy.
- Matching accuracy should be enforced through the governance of health information exchange participants and those using the Nationwide Health Information Exchange federal guidelines. The team determined, however, that no simple-to-use method of measuring accuracy exists, Egerman noted, so it decided not to set a "threshold" for accuracy levels that should be achieved.
- The ONC should develop and disseminate best practices for improving data capture and matching accuracy. ONC should conduct tests of matching strategies, fund development of innovative approaches and determine ideal ways to complete records corrections to eliminate errors caused by matching. "If we have organizations that are internally examining this issue and establishing improvement programs, that should generate some additional data that could be shared nationwide," McGraw said.
- Audit trails should enable patients to see where their information has been accessed, and patients should have an easy way to report corrections to their information.
Universal Exchange LanguageThe HIT Policy Committee also got an update from its PCAST Report Workgroup that's analyzing recommendations from the President's Council of Advisors on Science and Technology. The council called for creation of a universal exchange language to help make EHRs interoperable while protecting privacy.
The workgroup will hold a two-day hearing Feb. 15-16 in Washington to hear testimony from consumer groups, health information exchanges and others and begin formulating its analysis. It plans to present its final report to the HIT Policy Committee April 13 and to the HIT Standards Committee April 20.
Gayle Harrell, a consumer advocate who's a member of the HIT Policy Committee, expressed concerns that the council's recommendations would represent a major change in direction from the health information exchange and EHR interoperability approaches that ONC is already implementing. "We're spending a great deal of money right now going down a certain track ... and this seems to be going in a different direction," she said, echoing concerns expressed by others (See: EHR Interoperability: What Works?).
Harrell said she's concerned that statewide HIEs now in development would have to change their strategies midstream if the council's plan for a universal exchange language, which involves tagging specific data elements within EHRs with descriptive information, such as relevant privacy protections, is adopted. But Egerman, who also co-chairs the PCAST workgroup, replied: "Nothing in this report should cause anyone to do anything different right now." He stressed that the council is advocating "an evolutionary transition based the success of what ONC has done."
The PCAST workgroup is reviewing more than 100 comments it's received on the council's report.